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Holmes-Rahe Survey of Recent Experiences - Health Web

Asthma Control Test

Erection Questionnaire

Stress Test

 
Read each of the events listed below, and check the checkbox next to any event which has occurred in your life recently. There are no right or wrong answers. The aim is just to help identify which of these events you have experienced lately. A recent event is one which you think is till affecting you.
 
Death of spouse   Divorce
Marital separation   Jail term
Death of close family member   Personal injury of illness
Marriage   Fired at work
Marital reconciliation   Retirement
Change in health of family member   Pregnancy
Sex Difficulties   Gain of new family member
Business readjustment   Change of financial state
Death of close friend   Change to different line of work
Change in number of arguments with spouse   Mortgage over $30,000
Foreclosure of mortgage or loan   Change in responsibilities at work
Son or daughter leaving home   Trouble with in-laws
Outstanding personal achievement   Partner begins or stops work
Begin or end school   Change in living conditions
Revision of personal habits   Trouble with boss
Change in work hours or conditions   Change in residence
Change in schools   Change in recreation
Change in religious activities   Change in social activities
Mortgage or loan less than $30,000   Change in sleeping habits
Change in number of family get-togethers   Change in eating habits
Vacation   Christmas or other major festive season
Minor Violations of the law      

NOTE : The above checklist is developed based on the cultural value of U. S. population.

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